Download intravenous iron preparations comparison information (as per

>APPENDIX 2: INTRAVENOUS IRON PREPARATIONS
COMPARISON INFORMATION (AS PER PRODUCT
INFORMATION)
Ferric carboxymaltose
Iron sucrose
Iron polymaltose
Indication
Treatment of (laboratory diagnosed) iron deficiency
when oral iron preparations are ineffective or cannot
be used.
The treatment of (laboratory diagnosed) iron
deficiency anaemia in patients undergoing chronic
haemodialysis and who are receiving supplemental
erythropoietin therapy.
Treatment of iron deficiency anaemia when oral
therapy is contraindicated, enteric absorption of iron
is defective or when patient non-compliance or
persistent gastrointestinal intolerance makes oral
therapy impractical.
Iron concentration
(mg/mL)
50 mg/mL
20 mg/mL
50 mg/mL
Presentation
2 mL (100 mg ) or 10 mL (500 mg) vial
5 mL ampoules
2 mL ampoules
Maximum dose in a
single administration
for patients ≥35 kg
1000 mg (not more than 1000 mg per week)
(max 20 mg iron/kg body weight*)
100 mg not more than 3 times per week
Most patients will require a minimum cumulative dose
of 1000mg
2500 mg
Frequency of
administration
IV infusion: do not give more than1000mg iron per
week. Do not exceed calculated cumulative iron dose
or 20 mg iron/kg body weight.
IV bolus injection: max dose of 200mg no more than
3 times a week.
100mg no more than three times per week.
Rate of
administration
IV infusion:
100-200 mg
>200-500 mg
>500-1000 mg
Intravenous infusion 100 mg over 15 minutes.
For haemodialysis patients may be given slow IV
injection into the venous limb of the dialysis line at 1
mL (20 mg iron) per minute (ie. 5 minutes per
ampoule)
The first 50 mL should be infused slowly at 20-40
mL/hour
If tolerated may be increased to 120 mL/hour
No
Yes
Venofer®
Ferrosig® and Ferrum H®†
Total dose single
infusion
Link to Product
information
3 minutes
6 minutes
15 minutes
IV bolus injection:
200-500 mg @ 100 mg/min
>500 – 1000 mg over 15 mins
No
(Unless total body iron deficit is <1000 mg)
Ferinject®
Note: see links below for rapid infusion information
*Use ideal body weight in overweight patients. If underweight, use actual body weight
†
Whilst considered brand equivalent to Ferrosig®, Ferrum H® is not licensed for intravenous use in Australia – refer to Guiding Principles for the use of off-label medicines.1
See over for important consideration
National Blood Authority
IRON PRODUCT CHOICE AND DOSE CALCULATION – ADULTS JUNE 2015
pg. 1
Important considerations
Always refer to local health service guidelines/protocols and product information for the specific
iron preparation. Maximum doses per infusion, infusion rates and dilution are not interchangeable
between the different IV iron preparations.
Emerging data and regional practice indicate that alternative dosing and infusion schedules may
be practical and safe.1-3
There is also evolving evidence regarding the appropriateness of the three IV iron preparations in
varying clinical circumstances. If in doubt, refer to local guidelines/protocols or consult with an
expert haematologist.
Note: TEST DOSE NOT REQUIRED - The European Medicines Agency’s (EMA) Committee for
Medicinal Products for Human Use (CHMP)4 has considered that the current practice of first giving
the patient a small test dose is not a reliable way to predict how the patient will respond when the
full dose is given. A test dose is therefore no longer recommended but instead caution is warranted
with every dose of intravenous iron that is given, even if previous administrations have been well
tolerated.4
Current IV iron Product Information (PI) can be found on the Therapeutic Goods Administration
website: www.ebs.tga.gov.au - click on "Public TGA Information" in menu bar on left then click on
Product Information and enter product name in search box.
References:
1. Evstatiev R, Marteau P, Iqbal T, Khalif IL, Stein J, et al; FERGI Study Group. FERGIcor, a
randomized controlled trial on ferric carboxymaltose for iron deficiency anemia in inflammatory
bowel disease. Gastroenterology 2011;141:846-853.e2.
2. SA Maternal & Neonatal Clinical Network. Policy. Clinical Guideline. South Australian Perinatal
Practice Guidelines – iron infusion.
Available at: http://www.sahealth.sa.gov.au
3. Fremantle Hospital and Health Service, Department of Pharmacy. Specialised Drug Guidelines
regarding intravenous iron use: Iron sucrose.
Available at: http://www.health.wa.gov.au/bloodmanagement
4. European Medicines Agency (EMA). New recommendations to manage risk of allergic
reactions with intravenous iron-containing medicines. 28 June 2013. Available at:
http://www.ema.europa.eu/docs/en_GB/document_library/Press_release/2013/06/WC5001448
74.pdf
5. Council of Australian Therapeutic Advisory Groups (CATAG). Guiding Principles for the quality
use of off-label medicines. November 2013. Available at: http://www.catag.org.au/wpcontent/uploads/2012/08/OKA9963-CATAG-Rethinking-Medicines-Decision-Making-final.pdf
National Blood Authority
IRON PRODUCT CHOICE AND DOSE CALCULATION - ADULTS JUNE 2015
pg. 2